Updated No-Fault Reimbursement Schedules for Hospital: (A) Inpatient Services Rendered on and after July 1, 1991 (B) Outpatient Services Rendered on and after July 1, 1991.

November 4, 1991 SUBJECT: INSURANCE Circular Letter No. 18 (1991) WITHDRAWN TO: ALL AUTOMOBILE SELF-INSURERS and INSURERS LICENSED TO WRITE AUTOMOBILE INSURANCE IN NEW YORK RE: UPDATED NO-FAULT REIMBURSEMENT SCHEDULES FOR HOSPITAL: (A) INPATIENT SERVICES RENDERED ON & AFTER JULY 1, 1991 (B) OUTPATIENT SERVICES RENDERED ON & AFTER JULY 1, 1991 Pursuant to Regulation No. 83, 1NYCRR 68.2, the No-Fault rate schedules for reimbursing hospital services provided for under. Section 5102(0)(1) of the Insurance Law shall be for hospital: (A) inpatient services in conformity with Section 2807-c of the Public Health, Law as amended and (B) outpatient services, in conformity with Chapter 453 of the Laws of 1984. This Circular Letter advises No-Fault insurers that the State, of New York Department of Health has calculated revised rates of reimbursement for the period July 1, 1991 through December 31, 1991 for hospital inpatient services incurred in 1991 and hospital outpatient services rendered July 1, 1991 through June 30, 1992. Attached is a copy of the outpatient fee schedule. In addition, upon receipt of a written request from the senior claims officer of your company. the Insurance Department will furnish one copy of the 1991 DRG data to your Company. Since this data has been provided. to Workers" Compensation insurers, please request it only if you have not previously received it from another source. You should make this information available to all your claims personnel who are responsible for. the review of hospital inpatient billings payable under the No-Fault law. Written requests for the DRG. information- concerning inpatient hospital services can be sent to: New York State Insurance Department Property & Casualty insurance Bureau 160 West Broadway New York. NY 10043-3393 ATTN: Ms. Hoda Nairooz. Senior Examiner Any questions or problems with regard to the foregoing information should be brought to the attention of Ms. Nairooz at telephone no. (212) 602-8720. Very truly yours, [SIGNATURE] SALVATORE R. CURIALE SUPERINTENDENT OF INSURANCE STATE OF NEW YORK WORKERS" COMPENSATION BOARD OFFICE OF THE CHAIRWOMAN OUTPATIENT HOSPITAL FEE SCHEDULE Effective 7/1/91 - 6/30/92 The proposed Outpatient Hospital Fee Schedule was prepared and established pursuant to Chapter 453 Laws of 1984 and will be filed in the Office of the Department of State. This schedule will constitute Sections 329.6 and 329.7 of Title 12 of the Official Compilation of Codes, Rules and Regulations of the State of New York. These charges are for use in payment of claims under the Workers" Compensation Law, the Volunteer Firefighters" Benefit Law and the Volunteer Ambulance Workers" Benefit Law. In accordance with the amendments to Sec. 2500-d(6) of the public health law, effective 1-1-91, a hospital designated as a regional poison control center shall no longer be entitled to an add-on fee as part of this schedule. Barbara Patton Chairwoman WORKERS" COMPENSATION OUTPATIENT HOSPITAL RATE SCHEDULE WEST NEW YORK REGION EFFECTIVE 7/1/91 - 6/30/92 EMERGENCY SERVICE ROOM RATE ALLEGANY CUBA MEMORIAL HOSPITAL INC $ 9000 MEMORIAL HOSPITAL OF WM F & GERTRUDE F JONES A/K/A JONES MEMORIAL $ 47.00 CATTARAUGUS OLEAN GENERAL HOSPITAL $ 90.00 SALAMANCA HOSPITAL DISTRICT AUTHORITY $ 71.00 ST FRANCIS HOSPITAL OF OLEAN $ 45.00 TRI-COUNTY MEMORIAL HOSPITAL $ 90.00 CHAUTAUQUA BROOKS MEMORIAL HOSPITAL $ 61.00 LAKE SHORE HOSPITAL INC $ 67.00 WESTFIELD MEMORIAL HOSPITAL INC $ 52.00 WOMANS CHRISTIAN ASSOCIATION $ 46.00 ERIE BERTRAND CHAFFEE HOSPITAL $ 67.00 BUFFALO COLUMBUS HOSPITAL $ 90.00 BUFFALO GENERAL HOSPITAL $ 90.00 CHILDRENS HOSPITAL OF BUFFALO $ 61.00 ERIE COUNTY MEDICAL CENTER $ 90.00 KENMORE MERCY HOSPITAL $ 67.00 MERCY HOSPITAL. OF BUFFALO $ 58.00 MILLARD FILLMORE HOSPITAL $ 90.00 OUR LADY OF VICTORY HOSPITAL OF LACKAWANNA $ 90.00 ROSWELL PARK MEMORIAL INSTITUTE NO E.R. SERVICE SHEEHAN MEMORIAL EMERGENCY HOSPITAL INC. $ 90.00 SISTERS OF CHARITY HOSPITAL $ 57.00 ST JOSEPH INTERCOMMUNITY HOSPITAL $ 90.00 GENESEE GENESEE MEMORIAL HOSPITAL $ 69.00 ST JEROME HOSPITAL $ 82.00 EMERGENCY SERVICE ROOM RATE NIAGARA DEGRAFF MEMORIAL HOSPITAL $ 64.00 INTER-COMMUNITY MEMORIAL HOSPITAL AT NEWFANE INC $ 47.00 LOCKPORT MEMORIAL HOSPITAL $ 77.00 MOUNT ST MARYS HOSPITAL OF NIAGARA FALLS $ 72.00 NIAGARA FALLS MEMORIAL MEDICAL CENTER $ 86.00 ORLEANS MEDINA MEMORIAL HOSPITAL $ 79.00 WYOMING WYOMING COUNTY COMMUNITY HOSPITAL $ 74.00 WORKERS' COMPENSATION OUTPATIENT HOSPITAL RATE SCHEDULE ROCHESTER NEW YORK REGION. EFFECTIVE 7/1/91 - 6/30/92 EMERGENCY SERVICE ROOM RATE CHEMUNG ARNOT-OGDEN MEMORIAL HOSPITAL $ 90.00 ST JOSEPHS HOSPITAL OF ELMIRA $ 90.00 LIVINGSTON NICHOLAS H NOYES MEMORIAL HOSPITAL $ 66.00 MONROE GENESEE HOSPITAL OF ROCHESTER $ 90.00 HIGHLAND HOSPITAL OF ROCHESTER $ 90.00 LAKESIDE MEMORIAL HOSPITAL $ 81.00 MONROE COMMUNITY HOSPITAL NO E.R. SERVICE PARK RIDGE HOSPITAL $ 85.00 ROCHESTER GENERAL HOSPITAL $ 82.00 ST MARYS HOSPITAL OF ROCHESTER $ 83.00 STRONG MEMORIAL HOSPITAL $ 90.00 ONTARIO CLIFTON SPRINGS HOSPITAL AND CLINIC $ 90.00 F F THOMPSON HOSPITAL $ 90.00 GENEVA GENERAL HOSPITAL $ 76.00 SCHUYLER SCHUYLER HOSPITAL $ 64.00 SENECA WATERLOO MEMORIAL HOSPITAL INC D/B/A TAYLOR-BROWN MEMORIAL HOSP $ 90.00 STEUBEN CORNING HOSPITAL $ 71.00 IRA DAVENPORT MEMORIAL HOSPITAL INC $ 90.00 ST JAMES MERCY HOSPITAL $ 57.00 WAYNE MYERS COMMUNITY HOSPITAL FOUNDATION INC $ 84.00 NEWARK-WAYNE COMMUNITY HOSPITAL INC $ 90.00 YATES SOLDIERS AND SAILORS MEMORIAL $ 60.00 HOSPITAL OF YATES COUNTY INC WORKERS' COMPENSATION OUTPATIENT HOSPITAL RATE SCHEDULE CENTRAL NEW YORK REGION EFFECTIVE 7/1/91 - 6/30/92 EMERGENCY SEVICE ROOM RATE BROOME OUR LADY OF LOURDES MEMORIAL HOSPITAL $ 90.00 UNITED HEALTH SERVICES INC $ 89.00 CAYUGA AUBURN MEMORIAL HOSPITAL $ 64.00 CHENANGO CHENANGO MEMORIAL HOSPITAL INC $ 78.00 CORTLAND CORTLAND MEMORIAL HOSPITAL INC $ 61.00 HERKIMER LITTLE FALLS HOSPITAL $ 57.00 MOHAWK VALLEY GENERAL HOSPITAL $ 57.00 JEFFERSON CARTHAGE AREA HOSPITAL INC $ 89.00 EDWARD JOHN NOBLE HOSPITAL OF ALEXANDRIA BAY $ 74.00 HOUSE OF THE GOOD SAMARITAN $ 72.00 MERCY HOSPITAL OF WATERTOWN $ 90.00 LEWIS LEWIS COUNTY GENERAL HOSPITAL $ 70.00 MADISON COMMUNITY MEMORIAL HOSPITAL INC $ 63.00 ONEIDA CITY HOSPITAL $ 54.00 ONEIDA CHILDRENS HOSPITAL AND REHABILITATION CENTER NO E.R. SERVICE FAXTON HOSPITAL $ 51.00 ROME HOSPITAL AND MURPHY MEMORIAL HOSPITAL $ 68.00 ST ELIZABETH HOSPITAL $ 89.00 ST LUKES MEMORIAL HOSPITAL CENTER $ 12.00 ONONDAGA COMMUNITY GENERAL HOSPITAL OF GREATER SYRACUSE $ 90.00 GROUSE - IRVING MEMORIAL HOSPITAL $ 90.00 ST JOSEPHS HOSPITAL HEALTH CENTER $ 79.00 STATE UNIVERSITY HOSPITAL UPSTATE MEDICAL CENTER $ 90.00 OSWEGO ALBERT LINDLEY LEE MEMORIAL HOSPITAL $ 54.00 OSWEGO HOSPITAL $ 63.00 COMMON OR ORDINARY DRUGS COVERED BY THE EMERGENCY ROOM HOSPITAL RATES A study was undertaken to determine the low-cost drugs which a large number of hospitals in New York State regard as fairly common or ordinary and for which no charges are made apart from the inclusive Emergency Room rates. A partial list of such drugs is furnished below. It is expected that the list will be enlarged or augmented from time to time. In the meanwhile, the drugs shown below or on any future similar list or heretofore regarded as common or ordinary or any additional drugs so regarded should be considered as covered by the applicable Emergency Room rate. No charge should be made for any drugs, whether or not listed hereunder, in connection with hospitalized patients. Current list of "No Charge" Drugs and Pharmaceutical Supplies Acetaminophen 325 mg. tablet Lidocaine 2 percent with/without Epinephrine Alcohol 70 percent lidocaine 5 percent ointment Alcohol swabs. Lindane lotion (e.g. Kwell) Antacid (e.g. Mylanta, Maalox, etc.) Lubricating jelly. Aspirin 325 mg. tablet Magnesium Stilfsitf. Aromatic Spirits of Ammonia Meperidine injection (e.g. Demerol) Atropine 2 percent Ophthalmic Solution Merthiolate Atropine 0.4 mg/ml Neomycin and Polymyxin B Sulfates Bacitracin ointment w/Hydrocortisone ophthalmic suspension Castor Oil (e.g. Cortisporin) Calamine lotion Nitroglycerin 0.4 mg. s. 1. tablet Collodion Flexible Nitroglycerin 0.6 mg. s. 1. tablet Cold Cream Peppermint Spirit Chilliest tablets Petrolatum Dibucaine 1 percent ointment (e.g. Nupercainal) Providone-Iodine solution (e.g. Betadine), Epinephrine Injection Pralidoxime Chloride (e.g. Protopam) Ethyl Chloride spray Silver Nitrate Sticks Gelfoam Silver Sulfadiazine cream (e.g. Silvadene) Glycerin suppository Sodium Chloride - injection Hematest tablets Sodium Chloride for irrigation Hydrocortisone 1 percent ointment Sterile Water for irrigation Hydrogen Peroxide Talcum powder Iodine Tetanus Toxoid Ipecac Syrup Tuberculin PPD (1st and 2nd strength) Lidocaine 2 percent viscous (e.g. Xylocaine) Witch Hazel Lidocaine 1 percent with/without Epinephrine Zinc Oxide ointment WORKERS' COMPENSATION SCHEDULE OF RATES FOR OUTPATIENT HOSPITAL SERVICES Effective 7/1/91 - 6/30/92 Room other than operating room when used for minor surgery or emergency treatment: For the medical service provided whether by employed staff, attending staff or by contractual arrangement with the physician groups the fee for this service is the fee indicated in the Schedule of Medical Fees. For the hospital providing intern or resident staffing or by physician group contractual coverage the total fee is the fee for physician services as indicated in the Schedule of Medical Fees plus the fee for use of the Emergency Service Room as shown in this schedule. When the care is provided by an attending physician, the hospital fee is the Emergency Service Room fee as shown in this schedule, with the physician billing separately. Note: These fees include common or ordinary medications Crutches, mechanical splints and appliances Rental or Sale at Cost. Plaster Cast and/or Splint Cost of Plaster E.K.G., E.E.G., X-ray, P.T., and Laboratory Charges Rates in Schedule of Medical Fees Promulgated by the Chairman, Workers" Compensation Board Materials supplied by the Emergency Room (i.e. sterile trays, medications, etc.) over and above those usually included with the Emergency Room visit may be charged for separately. Itemize these on the bill submitted WORKERS' COMPENSATION OUTPATIENT HOSPITAL RATE SCHEDULE NORTHEASTERN NEW YORK REGION EFFECTIVE 7/1/91 - 6/30/92 EMERGENCY SERVICE ROOM RATE SARATOGA ADIRONDACK REGIONAL HOSPITAL $ 90.00 SARATOGA HOSPITAL $ 67.00 SCHENECTADY BELLEVUE MATERNITY HOSPITAL INC NO E.R. SERVICE ELLIS HOSPITAL$ 90.00 ST CLARES HOSPITAL OF SCHENECTADY $ 5 9.00 SUNNYVIEW HOSPITAL AND REHABILITATION CENTER NO E.R. SERVICE SCHOHARIE COMMUNITY HOSPITAL OF SCHOHARIE COUNTY INC $ 90.00 WARREN GLENS FALLS HOSPITAL $ 86.00 WASHINGTON MARY MCCLELLAN HOSPITAL $ 78.00 EMERGENCY SERVICE ROOM RATE DUTCHESS NORTHERN DUTCHESS HOSPITAL $ 66.00 ST FRANCIS HOSPITAL OF BEACON $ 84.00 ST FRANCIS HOSPITAL OF POUGHKEEPSIE $ 90.00 VASSAR BROTHERS HOSPITAL $ 83.00 ORANGE ARDEN HILL HOSPITAL $ 67.00 CORNWALL. HOSPITAL $ 88.00 E A HORTON MEMORIAL HOSPITAL $ 79.00 MERCY COMMUNITY HOSPITAL OF PORT JERVIS $ 90.00 ST ANTHONY COMMUNITY HOSPITAL $ 65.00 ST LUKES HOSPITAL OF NEWBURGH $ 84.00 PUTNAM JULIA BUTTERFIELD MEMORIAL HOSPITAL $ 62.00 PUTNAM COMMUNITY HOSPITAL $ 84.00 ROCKLAND GOOD SAMARITAN HOSPITAL OF SUFFERN $ 90.00 HELEN HAYES HOSPITAL NO E.R. SERVICE NYACK HOSPITAL $ 90.00 SUMMIT PARK HOSPITAL-ROCKLAND COUNTY INFIRMARY NO E.R. SERVICE SULLIVAN COMMUNITY GENERAL HOSPITAL OF SULLIVAN COUNTY-HARRIS DIV $ 75.00 COMMUNITY GENERAL HOSPITAL OF SULLIVAN COUNTY G HERMAN DIV $ 90.00 ULSTER BENEDICTINE HOSPITAL $ 75.00 ELLENVILLE COMMUNITY HOSPITAL $ 37.00 KINGSTON HOSPITAL $ 89.00 WESTCHESTER BLYTHEDALE CHILDRENS HOSPITAL NO. E.R. SERVICE BURKE REHABILITATION CENTER NO E.R. SERVICE DOBBS FERRY HOSPITAL $ 90.00 LAWRENCE HOSPITAL $ 90.00 WORKERS' COMPENSATION OUTPATIENT HOSPITAL RATE SCHEDULE CENTRAL NEW YORK REGION EFFECTIVE 7/1/91 - 6/30/92 EMERGENCY SERVICE ROOM RATE ST LAWRENCE A BARTON HEPBURN HOSPITAL $ 90.00 CANTON-POTSDAM HOSPITAL $ 66.00 CLIFTON-FINE HOSPITAL $ 47.00 EDWARD JOHN NOBLE HOSPITAL OF GOUVERNEUR $ 63.00 MASSENA MEMORIAL HOSPITAL $ 90.00 TOMPKINS TOMPKINS COUNTY HOSPITAL $ 55.00 WORKERS" COMPENSATION OUTPATIENT HOSPITAL RATE SCHEDULE NORTHEASTERN NEW YORK REGION EFFECTIVE 7/1/91 - 6/30/92 EMERGENCY SERVICE ROOM RATE ALBANY ALBANY MEDICAL CENTER HOSPITAL $ 90.00 CHILDS HOSPITAL NO E.R. SERVICE MEMORIAL HOSPITAL OF ALBANY $ 90.00 ST PETERS HOSPITAL $ 90.00 CLINTON CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CTR $ 67.00 COLUMBIA COLUMBIA - GREENE MEDICAL CENTER $ 76.00 DELAWARE A LINDSAY & OLIVE B OCONNOR HOSPITAL $ 90.00 COMMUNITY HOSPITAL OF STAMFORD $ 90.00 DELAWARE VALLEY HOSPITAL INC $ 90.00 MARGARETVILLE MEMORIAL HOSPITAL $ 90.00 THE HOSPITAL $ 71.00 ESSEX ELIZABETHTOWN COMMUNITY HOSPITAL $ 90.00 MOSES-LUDINGTON HOSPITAL $ 77.00 PLACID MEMORIAL HOSPITAL INC (ADIRONDACK MEDICAL CENTER) $ 90.00 FRANKLIN ALICE HYDE MEMORIAL HOSPITAL $ 88.00 GENERAL HOSPITAL OF SARANAC LAKE (ADIRONDACK MEDICAL CENTER) $ 90.00 FULTON NATHAN LITTAUER HOSPITAL $ 72.00 GREENE MEMORIAL HOSPITAL AND NURSING HOME OF GREENE COUNTY SEE COLUMBIA-GREENE MEDICAL CENTER MONTGOMERY AMSTERDAM MEMORIAL HOSPITAL $ 90.00 ST MARYS HOSPITAL AT AMSTERDAM $ 78.00 OTSEGO AURELIA OSBORN FOX MEMORIAL HOSPITAL $ 90.00 MARY IMOGENE BASSETT HOSPITAL $ 90.00 RENSSELAER LEONARD HOSPITAL $ 90.00 SAMARITAN HOSPITAL OF TROY $ 83.00 ST MARYS HOSPITAL OF TROY $ 90.00 WORKERS' COMPENSATION OUTPATIENT HOSPITAL RATE SCHEDULE NEWYORK CITY REGION EFFECTIVE 7/1/91 - 6/30/92 EMERGENCY SERVICE ROOM RATE ASTORIA GENERAL HOSPITAL $ 90.00 BAYLEY SETON HOSPITAL $ 90.00 BETH ISRAEL MEDICAL CENTER $ 90.00 BOOTH MEMORIAL MEDICAL CENTER $ 90.00 BRONX-LEBANON HOSPITAL CENTER $ 90.00 BROOKDALE HOSPITAL MEDICAL CENTER $ 90.00 BROOKLYN/CALEDONIAN HOSPITAL $ 90.00 CABRINI HEALTH CARE CTR $ 90.00 CALVARY HOSPITAL NO E.R. SERVICE CATHOLIC MEDICAL CENTER $ 90.00 COMMUNITY HOSPITAL OF BROOKLYN INC. $ 90.00 DEEPDALE GENERAL HOSPITAL $ 59.00 DOCTORS HOSPITAL INC $ 90.00 DOCTORS HOSPITAL OF STATEN ISLAND $ 90.00 FLUSHING HOSPITAL AND MEDICAL CENTER $ 90.00 HIP HOSPITAL INC (LA GUARDIA) $ 90.00 HOSPITAL FOR JOINT DISEASES AND MEDICAL CENTER ORTHOPEDIC INSTITUTE NO E.R. SERVICE HOSPITAL FOR SPECIAL SURGERY NO E.R. SERVICE INSTITUTE OF REHAB MEDICINE NY UNIVERSITY (RUSK INSTITUTE) NO E.R. SERVICE INTERFAITH MEDICAL CENTER $ 90.00 JAMAICA HOSPITAL $ 90.00 JOINT DISEASES NORTH GENERAL HOSPITAL $ 90.00 KINGS HIGHWAY HOSPITAL $ 77.00 KINGSBROOK JEWISH MEDICAL CENTER $ 90.00 LENOX HILL HOSPITAL $ 90.00 LONG ISLAND COLLEGE HOSPITAL $ 90.00 LONG ISLAND JEWISH-HILLSIDE MED CTR $ 90.00 LUTHERAN MEDICAL CENTER $ 90.00 MAIMONIDES MEDICAL CENTER $ 90.00 EMERGENCY SERVICE ROOM RATE MANHATTAN EYE EAR AND THROAT HOSPITAL $ 71.00 MEDICAL ARTS CENTER HOSPITAL $ 90.00 MEMORIAL HOSPITAL FOR CANCER AND $ 90.00 ALLIED DISEASES METHODIST HOSPITAL OF BROOKLYN $ 90.00 MONTEFIORE HOSPITAL & MEDICAL CENTER $ 90.00 MOUNT SINAI HOSPITAL $ 90.00 NY EYE AND EAR INFIRMARY $ 46.00 NEW YORK HOSPITAL AND PAYNE $ 90.00 WHITNEY PSYCHIATRIC CLINIC NY INFIRMARY BEEKMAN DOWNTOWN HOSPITAL $ 84.00 NY UNIVERSITY MEDICAL CENTER - TISCH HOSPITAL $ 90.00 OUR LADY OF MERCY MEDICAL CENTER $ 90.00 PARKWAY HOSPITAL $ 90.00 PELHAM BAY GENERAL HOSPITAL NO E.R. SERVICE PENINSULA HOSPITAL CENTER $ 90.00 PRESBYTERIAN HOSPITAL IN THE CITY OF NEW YORK $ 90.00 RICHMOND MEMORIAL HOSPITAL AND HEALTH CENTER $ 90.00 ROCKEFELLER UNIVERSITY HOSPITAL NO E.R. SERVICE ST BARNABAS HOSPITAL $ 90.00 ST CLARES HOSPITAL AND HEALTH CENTER $ 90.00 ST JOHNS EPISCOPAL HOSPITAL $ 90.00 (CHURCH CHARITY FOUNDATION) ST LUKES - ROOSEVELT HOSPITAL CENTER $ 90.00 ST MARYS HOSPITAL OF BROOKLYN - SEE CATHOLIC MEDICAL CENTER ST VINCENTS HOSPITAL AND MEDICAL CENTER OF NY $ 90.00 ST VINCENTS MEDICAL CENTER OF RICHMOND $ 90.00 STATE UNIVERSITY HOSPITAL NO E.R. SERVICE DOWNSTATE MEDICAL CENTER STATEN ISLAND HOSPITAL $ 90.00 WORKERS' COMPENSATION OUTPATIENT HOSPITAL RATE SCHEDULE NORTHERN METROPOLITAN REGION EFFECTIVE 7/1/91 - 6/30/92 EMERGENCY SERVICE ROOM RATE WESTCHESTER MOUNT VERNON HOSPITAL $ 90.00 NEW ROCHELLE HOSPITAL MEDICAL CENTER $ 90.00 NEW YORK HOSPITAL-CORNELL MEDICAL NO E.R. SERVICE CENTER WESTCHESTER DIVISION NORTHERN WESTCHESTER HOSPITAL $ 90.00 PEEKSKILL HOSPITAL $ 69.00 PHELPS MEMORIAL HOSPITAL ASSOCIATION $ 90.00 ST AGNES HOSPITAL $ 90.00 ST JOHNS RIVERSIDE HOSPITAL $ 90.00 ST JOSEPHS HOSPITAL YONKERS $ 69.00 ST VINCENTS HOSP AND MEDICAL CTR NO E.R. SERVICE OF NY WESTCHESTER BRANCH UNITED HOSPITAL $ 90.00 WESTCHESTER COUNTY MEDICAL CENTER $ 90.00 WHITE PLAINS HOSPITAL MEDICAL CENTER $ 90.00 YONKERS GENERAL HOSPITAL $ 90.00 WORKERS' COMPENSATION OUTPATIENT HOSPITAL RATE SCHEDULE LONG ISLAND REGION EFFECTIVE 7/1/91 - 6/30/92 EMERGENCY SERVICE ROOM RATE NASSAU CENTRAL GENERAL HOSPITAL $ 90.00 COMMUNITY HOSPITAL AT GLEN COVE $ 90.00 FRANKLIN GENERAL HOSPITAL $ 90.00 HEMSTEAD GENERAL HOSPITAL $ 90.00 LONG BEACH MEMORIAL HOSPITAL $ 90.00 LONG ISLAND JEWISH - MEDICAL CENTER (MANHASSET DIV.) $ 90.00 MASSAPEQUA GENERAL HOSPITAL $ 90.00 MERCY HOSPITAL OF ROCKVILLE CENTRE $ 90.00 MID - ISLAND HOSPITAL $ 90.00 NASSAU COUNTY MEDICAL CENTER $ 90.00 EAST MEADOW DIV NORTH SHORE UNIVERSITY HOSPITAL $ 90.00 SOUTH NASSAU COMMUNITIES HOSPITAL $ 76.00 ST FRANCIS HOSPITAL OF ROSLYN $ 90.00 SYOSSET COMMUNITY HOSPITAL $ 90.00 WINTHROP - UNIVERSITY HOSPITAL $ 90.00 (NASSAU HOSPITAL) SUFFOLK BROOKHAVEN MEMORIAL HOSPITAL $ 90.00 BRUNSWICK HOSPITAL CENTER INC $ 48.00 CENTRAL SUFFOLK HOSPITAL ASSOCIATION $ 90.00 COMMUNITY HOSPITAL OF WESTERN SUFFOLK $ 80.00 EASTERN LONG ISLAND HOSPITAL $ 90.00 GOOD SAMARITAN HOSPITAL OF WEST ISLIP $ 90.00 HUNTINGTON HOSPITAL $ 90.00 JOHN T MATHER MEMORIAL HOSPITAL OF $ 90.00 PORT JEFFERSON NEW YORK INC SOUTHAMTON HOSPITAL $ 90.00 SOUTHSIDE HOSPITAL $ 90.00 ST CHARLES HOSPITAL $ 90.00 ST JOHNS EPISCOPAL HOSPITAL SMITHTOWN (EPISCOPAL HEALTH SERVICE) $ 90.00 UNIVERSITY HOSPITAL OF STONY BROOK $ 90.00 WORKERS' COMPENSATION OUTPATIENT HOSPITAL RATE SCHEDULE NEW YORK CITY REGION EFFECTIVE 7/1/91 - 6/30/92 EMERGENCY SERVICE ROOM RATE UNION HOSPITAL OF THE BRONX $ 83.00 VICTORY MEMORIAL HOSPITAL $ 90.00 WESTCHESTER SQUARE HOSPITAL $ 90.00 WYCKOFF HEIGHTS HOSPITAL $ 90.00 HEALTH AND HOSPITAL CORPORATION BELLEVUE HOSPITAL CENTER $ 90.00 BRONX MUNICIPAL HOSPITAL CENTER $ 90.00 CITY HOSPITAL CENTER AT ELMHURST $ 87.00 COLER MEMORIAL. HOSPITAL AND HOME NO E.R. SERVICE CONEY ISLAND HOSPITAL $ 90.00 GOLDWATER MEMORIAL HOSPITAL NO E.R. SERVICE HARLEM HOSPITAL CENTER $ 90.00 KINGS COUNTY HOSPITAL CENTER $ 64.00 LINCOLN MEDICAL & MENTAL HEALTH CENTER $ 90.00 METROPOLITAN HOSPITAL CENTER $ 90.00 NORTH CENTRAL BRONX HOSPITAL $ 90.00 QUEENS HOSPITAL CENTER $ 90.00 WOODHULL MEDICAL AND MENTAL HEALTH CENTER $ 90.00